SAM URETSKY

GOP Congress Lights Medicare Fuse

No, the proposed Medicare "reform" is not better than nothing. The
fact is, our representatives in Congress, mostly Republicans, but
aided and abetted by Sens. Max Baucus of Montana and John B. Breaux
of Louisiana, nominally Democrats, have put together a trap for the
foolish. The goal is simple: Under the guise of offering a
prescription drug benefit as part of Medicare, throw money at
insurance companies and drug companies, and while you're at it,
privatize the most successful program since Social Security. The
congressional Republicans have an impressive record of convincing
people to vote against their own self interest, and it appears
they're about to do it again.

In this case, they're using one of the oldest tricks in the
medical researcher's armamentarium: Set up the study to get exactly
the results you want, then announce the results without discussing
the methods. In medical studies it's easy. You compare a drug that
needs three doses a day with a new one that requires only one dose a
day, but give them both only once a day. The hardest part is to keep
a straight face when you announce that the new drug works better than
the older treatment. Congress has learned from the drug companies,
and is showing off its talents.

Medicare has been a very successful program, but unfortunately,
it hasn't kept up with changes in health care. When the program was
first designed, hospital costs were the most expensive part of most
health care, while out-patient medications were simply an annoyance.
Over time, drug therapy has become more effective and more expensive,
while hospitalization has been largely replaced by home care. For
many Medicare recipients, the cost of drugs is ruinous, to the point
where it's a matter of choice whether to take prescribed medication
or eat. Some elderly people take half doses of their medication in
order to reduce the cost; others live on pet foods in order to save
the money needed for medication. A prescription drug benefit as part
of Medicare is badly needed.

To congressional Republicans, this is an opportunity, not to help
millions of people in need, but to sell out Medicare to the insurance
companies. Tacked into the prescription drug bill are provisions to
pay the commercial insurance companies to offer their own plans.
There will be trials in selected urban areas to compare the costs of
traditional Medicare against the commercial insurers, and
recommendations for changes to the Medicare program will be based on
the results of these trials.

For practical purposes, this test has already been performed. The
Medicare+Choice program was designed to induce private insurers to
offer health policies to Medicare beneficiaries. The government paid
the insurance companies a bonus for offering these policies, but even
though the Medicare+Choice plans offered some benefits that weren't
available through traditional Medicare, relatively few people
enrolled. Those who did enroll often found that they had higher
out-of-pocket costs than they had under traditional Medicare. They
were forced to use network physicians, and couldn't count on their
insurer staying around from one year to the next, since the private
companies were quick to pull out of areas where they weren't making
adequate profits. According to a report from the Kaiser Family
Foundation, between 1999 and 2001 nearly half of the insurance
companies offering Medicare+Choice withdrew from either the program,
or selected geographic areas, leaving 1.6 million with interruptions
in coverage.

The track record of insurance companies has been so poor that
Congress had to stack the deck, and they did. According to the rules
they're prepared to set, traditional Medicare must buy all the drugs
for its prescription benefit plan at full list price. It may not
negotiate with suppliers for better prices, may not place limits on
the drugs used. It's like going to a supermarket and not taking
coupons. Meanwhile, the insurance companies are free to use every
cost cutting device known. If, at the end of the trial period, it
turns out that the private insurers cost less than traditional
Medicare, what will have been proven? Mostly that a Republican
Congress knows how to set things up to get the results they wanted in
the first place.

When the trial period is over, there will be a report showing
that the private insurers were able to provide prescription coverage
at a lower price than the government program, leading to the
conclusion that privatization of Medicare will save money. The detail
about traditional Medicare being barred from even the most basic cost
containment methods will be tucked into a footnote, or completely
forgotten. The results will prove the advantages of private health
insurance and Medicare will be tossed to the wolves.

All politicians stretch the truth, and some do it like a
mezzo-soprano in bicycle shorts, but the idea of setting up a
deception years in advance is an advance in the technique. It's a
sure bet that the Prescription Plan will be passed &endash;- no one
can explain the problems with this bill in a five-second sound bite.
But it contains a time bomb that, if neglected, could destroy
Medicare.